ATI PN Fundamentals Proctored Examination
2026/2027 Next Generation NCLEX Items ACTUAL
EXAM 2026/2027 | ATI PN Fundamentals NGN
Verified Q&A | Pass Guaranteed - A+ Graded
NGN-Style Clinical Judgment & Prioritization (Questions 1–20)
Q1: A PN is assigned to four patients on a medical-surgical unit. Patient A is a 78-year-old with new-
onset confusion and a temperature of 101.8°F. Patient B is a 45-year-old postoperative day 2 requesting
pain medication. Patient C is a 62-year-old with stable vital signs due for a routine dressing change.
Patient D is a 55-year-old with COPD whose oxygen saturation dropped from 94% to 88% on 2 L/min
nasal cannula. Which patient should the PN see first?
A. Patient A
B. Patient B
C. Patient C
D. Patient D [CORRECT]
Correct Answer: D
Rationale: This choice is correct because an oxygen saturation drop to 88% signals acute respiratory
compromise that can deteriorate rapidly into respiratory failure—this life-threatening change demands
immediate assessment and intervention before any other patient needs.
Q2: A PN is caring for a patient who is postoperative day 1 after appendectomy. The patient reports
increasing abdominal pain, has not passed flatus, and the abdomen is distended and tympanic. The PN
recognizes these cues as most consistent with:
A. Normal postoperative recovery
B. Paralytic ileus requiring provider notification [CORRECT]
C. Wound infection
D. Urinary retention
Correct Answer: B
,Rationale: Increasing pain, absent flatus, and a tympanic distended abdomen are classic cues for
paralytic ileus after abdominal surgery—this isn't normal recovery and needs prompt provider
evaluation to prevent bowel obstruction or perforation.
Q3: A PN receives a report from the night shift that a patient with heart failure has gained 3 pounds
overnight, has crackles in the lung bases, and reports increased shortness of breath when lying flat. The
PN analyzes these cues and determines the patient is most likely experiencing:
A. Dehydration
B. Fluid volume overload [CORRECT]
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: Rapid weight gain, crackles, and orthopnea are the triad of fluid overload in heart failure—
this patient's body is retaining fluid faster than the heart can pump it out, and diuretics or other
interventions are needed urgently.
Q4: A PN is caring for a patient with diabetes who has a foot ulcer. The PN notes the wound has
purulent drainage, the surrounding skin is erythematous and warm, and the patient has a temperature
of 101.5°F. The PN's priority hypothesis is:
A. The wound is healing normally
B. The wound is infected and requires immediate provider notification [CORRECT]
C. The patient has developed a pressure injury
D. The patient is experiencing an allergic reaction to the dressing
Correct Answer: B
Rationale: Purulent drainage, spreading erythema, warmth, and fever are textbook infection cues in a
diabetic foot wound—this isn't normal healing and needs immediate escalation because diabetic foot
infections can progress to osteomyelitis or sepsis rapidly.
Q5: A PN is reviewing the morning vital signs for assigned patients. Which set of vital signs represents
the most urgent clinical cue requiring immediate action?
, A. BP 138/82, HR 78, RR 16, Temp 98.6°F, SpO2 96%
B. BP 92/58, HR 112, RR 24, Temp 99.1°F, SpO2 91% [CORRECT]
C. BP 128/76, HR 88, RR 18, Temp 100.2°F, SpO2 94%
D. BP 146/90, HR 82, RR 20, Temp 98.8°F, SpO2 95%
Correct Answer: B
Rationale: Hypotension, tachycardia, tachypnea, and hypoxemia together signal shock or severe
respiratory compromise—this pattern of compensatory mechanisms failing is the most life-threatening
and needs immediate intervention.
Q6: A PN is caring for a patient who is receiving a blood transfusion. Fifteen minutes after starting the
transfusion, the patient reports chills, back pain, and a temperature of 101.2°F. The PN recognizes these
cues as indicating:
A. A mild allergic reaction
B. An acute hemolytic transfusion reaction [CORRECT]
C. Circulatory overload
D. Febrile non-hemolytic reaction only
Correct Answer: B
Rationale: Chills, back pain, and fever within minutes of starting a transfusion are the hallmark cues of
acute hemolytic reaction—this is a medical emergency requiring immediate transfusion cessation and
provider notification.
Q7: A PN is caring for a patient who is postoperative and has a Foley catheter. The urine output for the
past hour is 15 mL. The PN's previous assessment documented 45 mL/hour. The PN's best next action is:
A. Increase the patient's oral fluid intake
B. Assess for catheter kinks or obstruction, check vital signs, and notify the RN or provider [CORRECT]
C. Document the finding and continue monitoring
D. Irrigate the catheter with sterile saline
Correct Answer: B
2026/2027 Next Generation NCLEX Items ACTUAL
EXAM 2026/2027 | ATI PN Fundamentals NGN
Verified Q&A | Pass Guaranteed - A+ Graded
NGN-Style Clinical Judgment & Prioritization (Questions 1–20)
Q1: A PN is assigned to four patients on a medical-surgical unit. Patient A is a 78-year-old with new-
onset confusion and a temperature of 101.8°F. Patient B is a 45-year-old postoperative day 2 requesting
pain medication. Patient C is a 62-year-old with stable vital signs due for a routine dressing change.
Patient D is a 55-year-old with COPD whose oxygen saturation dropped from 94% to 88% on 2 L/min
nasal cannula. Which patient should the PN see first?
A. Patient A
B. Patient B
C. Patient C
D. Patient D [CORRECT]
Correct Answer: D
Rationale: This choice is correct because an oxygen saturation drop to 88% signals acute respiratory
compromise that can deteriorate rapidly into respiratory failure—this life-threatening change demands
immediate assessment and intervention before any other patient needs.
Q2: A PN is caring for a patient who is postoperative day 1 after appendectomy. The patient reports
increasing abdominal pain, has not passed flatus, and the abdomen is distended and tympanic. The PN
recognizes these cues as most consistent with:
A. Normal postoperative recovery
B. Paralytic ileus requiring provider notification [CORRECT]
C. Wound infection
D. Urinary retention
Correct Answer: B
,Rationale: Increasing pain, absent flatus, and a tympanic distended abdomen are classic cues for
paralytic ileus after abdominal surgery—this isn't normal recovery and needs prompt provider
evaluation to prevent bowel obstruction or perforation.
Q3: A PN receives a report from the night shift that a patient with heart failure has gained 3 pounds
overnight, has crackles in the lung bases, and reports increased shortness of breath when lying flat. The
PN analyzes these cues and determines the patient is most likely experiencing:
A. Dehydration
B. Fluid volume overload [CORRECT]
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: Rapid weight gain, crackles, and orthopnea are the triad of fluid overload in heart failure—
this patient's body is retaining fluid faster than the heart can pump it out, and diuretics or other
interventions are needed urgently.
Q4: A PN is caring for a patient with diabetes who has a foot ulcer. The PN notes the wound has
purulent drainage, the surrounding skin is erythematous and warm, and the patient has a temperature
of 101.5°F. The PN's priority hypothesis is:
A. The wound is healing normally
B. The wound is infected and requires immediate provider notification [CORRECT]
C. The patient has developed a pressure injury
D. The patient is experiencing an allergic reaction to the dressing
Correct Answer: B
Rationale: Purulent drainage, spreading erythema, warmth, and fever are textbook infection cues in a
diabetic foot wound—this isn't normal healing and needs immediate escalation because diabetic foot
infections can progress to osteomyelitis or sepsis rapidly.
Q5: A PN is reviewing the morning vital signs for assigned patients. Which set of vital signs represents
the most urgent clinical cue requiring immediate action?
, A. BP 138/82, HR 78, RR 16, Temp 98.6°F, SpO2 96%
B. BP 92/58, HR 112, RR 24, Temp 99.1°F, SpO2 91% [CORRECT]
C. BP 128/76, HR 88, RR 18, Temp 100.2°F, SpO2 94%
D. BP 146/90, HR 82, RR 20, Temp 98.8°F, SpO2 95%
Correct Answer: B
Rationale: Hypotension, tachycardia, tachypnea, and hypoxemia together signal shock or severe
respiratory compromise—this pattern of compensatory mechanisms failing is the most life-threatening
and needs immediate intervention.
Q6: A PN is caring for a patient who is receiving a blood transfusion. Fifteen minutes after starting the
transfusion, the patient reports chills, back pain, and a temperature of 101.2°F. The PN recognizes these
cues as indicating:
A. A mild allergic reaction
B. An acute hemolytic transfusion reaction [CORRECT]
C. Circulatory overload
D. Febrile non-hemolytic reaction only
Correct Answer: B
Rationale: Chills, back pain, and fever within minutes of starting a transfusion are the hallmark cues of
acute hemolytic reaction—this is a medical emergency requiring immediate transfusion cessation and
provider notification.
Q7: A PN is caring for a patient who is postoperative and has a Foley catheter. The urine output for the
past hour is 15 mL. The PN's previous assessment documented 45 mL/hour. The PN's best next action is:
A. Increase the patient's oral fluid intake
B. Assess for catheter kinks or obstruction, check vital signs, and notify the RN or provider [CORRECT]
C. Document the finding and continue monitoring
D. Irrigate the catheter with sterile saline
Correct Answer: B
